Vagus nerve stimulation: Potential for treating chronic wounds

Author: Anuj Budhiraja1, Alisha Mehta1, Moyasar A Alhamo2, Richard Swedarsky3, Sara Dahle2,4, R Rivkah Isseroff2,5
1 California Northstate University College of Medicine, Elk Grove, California, USA.
2 Department of Dermatology, University of California, Davis, California, USA.
3 Virginia Mason Franciscan Health, Tacoma, Washington, USA.
4 Podiatry Section, VA Northern California Health Care System, California, USA.
5 Dermatology Section, VA Northern California Health Care System, California, USA.
Conference/Journal: Wound Repair Regen
Date published: 2024 Jan 18
Other: Special Notes: doi: 10.1111/wrr.13151. , Word Count: 275

Vagus nerve stimulation (VNS) has been approved as a treatment for various conditions, including drug-resistant epilepsy, migraines, chronic cluster headaches and treatment-resistant depression. It is known to have anti-inflammatory, anti-nociceptive and anti-adrenergic effects, and its therapeutic potential for diverse pathologies is being investigated. VNS can be achieved through invasive (iVNS) or non-invasive (niVNS) means, targeting different branches of the vagus nerve. iVNS devices require surgical implantation and have associated risks, while niVNS devices are generally better tolerated and have a better safety profile. Studies have shown that both iVNS and niVNS can reduce inflammation and pain perception in patients with acute and chronic conditions. VNS devices, such as the VNS Therapy System and MicroTransponder Vivistim, have received Food and Drug Administration approval for specific indications. Other niVNS devices, like NEMOS and gammaCore, have shown effectiveness in managing epilepsy, pain and migraines. VNS has also demonstrated potential in autoimmune disorders, such as rheumatoid arthritis and Crohn's disease, as well as neurological disorders like epilepsy and migraines. In addition, VNS has been explored in cardiovascular disorders, including post-operative atrial fibrillation and myocardial ischemia-reperfusion injury, and has shown positive outcomes. The mechanisms behind VNS's effects include the cholinergic anti-inflammatory pathway, modulation of cytokines and activation of specialised pro-resolving mediators. The modulation of inflammation by VNS presents a promising avenue for investigating its potential to improve the healing of chronic wounds. However, more research is needed to understand the specific mechanisms and optimise the use of VNS in wound healing. Ongoing clinical trials may support the use of this modality as an adjunct to improve healing.

Keywords: chronic wound; inflammation; pain; vagus nerve; vagus nerve stimulation.

PMID: 38235529 DOI: 10.1111/wrr.13151